Editor—Patients presenting with acute upper airway obstruction are at significant risk of morbidity and continue to be managed poorly.1 Although several approaches can be taken, surgical tracheostomy placement under local anaesthesia is recommended because it ensures patients are kept awake, maintaining airway patency.2 This poses several challenges for the anaesthetist, including limited access to the surgical field and risk of complete airway obstruction in a patient with potentially limited reserve.
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